scholarly journals Solitary Lung Metastasis of Prostate Cancer with a Long Disease-Free Interval and Normal Prostate-Specific Antigen Level

2021 ◽  
pp. 284-289
Author(s):  
Hiroyuki Yoshitake ◽  
Shoji Oura ◽  
Tomoyuki Yamaguchi ◽  
Shinichiro Makimoto
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Antigen ◽  
Lung Metastasis ◽  
Specific Antigen ◽  
Middle Lobe ◽  
Primary Adenocarcinoma ◽  
Wide Resection ◽  
Normal Prostate ◽  
Solid Nodule

An 83-year-old man with core needle biopsy-proven Gleason score 5 prostate cancer had received radiotherapy including 18 Gy brachytherapy to the prostate cancer, leading to no locoregional and distant recurrence for more than 5 years with the normalization of elevated prostate-specific antigen (PSA) level before the radiotherapy. Due to the enlargement of coexisting ground glass nodule (GGN) in the left lung from 1 to 2.1 cm, the patient underwent wide resection of the GGN 7 years later. Under the diagnosis of adenocarcinoma in situ of the lung, follow-up computed tomography 6 months after the wide resection showed a rapid enlargement of a solid nodule having been judged as a presumed inflammatory nodule in the middle lobe, highly suggesting a malignant neoplasm of the lung. Due to both the tall columnar atypical cells with trabecular pattern on frozen section and no elevation of serum PSA level, we judged the nodule as a primary adenocarcinoma of the lung and further resected the middle lobe with lymph node dissection. Immunostaining of the tumor showed all the CK7, CK20, TTF-1, napsin A, synaptophysin, chromogranin, CD56, CDX2, p53, beta-catenin, and MUC2 negative, and PSA highly positive, clearly showing the solid nodule as a solitary lung metastasis of the prostate cancer. Physicians should note the possible solitary lung metastasis of prostate cancer, especially bearing indolent biology, with no elevation of the PSA level even after the completion of standard 5-year follow-up.

scholarly journals Solitary Lung Metastasis From Primary Prostate Cancer With Normal Prostate Specific Antigen Level: a Case Report and Literature Review

2021 ◽  
Author(s):  
Natsumi Maru ◽  
Asako Okabe ◽  
Haruaki Hino ◽  
Takahiro Utsumi ◽  
Hiroshi Matsui ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Literature Review ◽  
Prostate Specific Antigen ◽  
Lung Metastasis ◽  
Specific Antigen ◽  
Prostate Specific Antigen Level ◽  
Low Grade ◽  
Antigen Level ◽  
Normal Prostate ◽  
Term Survival

Abstract Background: Pulmonary involvement from prostate cancer is a well-known condition, but solitary lung metastasis is rare, with its associated clinical characteristics not yet fully elucidated.Case presentation: A 77-year-old man, with a history of radical prostatectomy for primary prostatic carcinoma 14 years prior, presented to our institution with a low-grade fever. Upon consultation, biochemical recurrence was suspected due to a gradual increase in prostate-specific antigen level. Salvage radiation therapy was considered but not performed since there was no recurrent macroscopic tumor. Computed tomography showed a solitary nodule with spiculation located on the upper lobe of the left lung while positron emission tomography suggested malignancy without metastasis. Based on these findings, primary lung cancer was suspected and thoracoscopic left upper lobectomy with lymph node dissection was performed. Pathological diagnosis of the tumor was a solitary lung metastasis of prostate cancer. The postoperative recovery was uneventful. Conclusion: We report a case with normal prostate-specific antigen level, along with a literature review. According to previous case reports, there are some pitfalls leading misdiagnosis as a primary lung tumor. However, we consider that surgical resection is associated with increased diagnostic accuracy and long-term survival.

scholarly journals Early detection of prostate cancer local recurrence by urinary prostate-specific antigen

2013 ◽  
Vol 3 (3) ◽  
pp. 213 ◽  
Author(s):  
Stéphane Bolduc ◽  
Brant A. Inman ◽  
Louis Lacombe ◽  
Yves Fradet ◽  
Roland R. Tremblay
Keyword(s):  
Prostate Cancer ◽  
Early Detection ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Laboratory Assessment ◽  
Cross Sectional ◽  
Prostatectomie Radicale ◽  
Psa Recurrence ◽  
Patients Atteints De Cancer

Purpose: We assessed the role of urinary prostate-specific antigen(uPSA) in the follow-up of prostate cancer after retropubic radicalprostatectomy (RRP) for the early detection of local recurrences.Methods: We recruited 50 patients previously treated for prostatecancer with RRP and who had not experienced a prostatespecificantigen (PSA) recurrence within their first postoperativeyear into a cross-sectional laboratory assessment and prospective6-year longitudinal follow-up study. We defined biochemicalfailure as a serum PSA (sPSA) of 0.3 μg/L or greater. Patientsprovided blood samples and a 50-mL sample of first-voided urine.We performed Wilcoxon rank-sum and Fisher exact tests for statisticalanalysis.Results: The median sPSA was 0.13 μg/L. The median uPSA was0.8 μg/L, and was not significantly different when comparingGleason scores or pathological stages. Of the 50 patients, 27 initiallyhad a nondetectable sPSA but a detectable uPSA, and11 patients experienced sPSA failure after 6 years. Six patients haddetectable sPSA and uPSA initially. Fifteen patients were negativefor both sPSA and uPSA, and 13 remained sPSA-free after 6 years.The odds ratio (OR) of having sPSA failure given a positive uPSAtest was 4.5 if sPSA was undetectable, but was reduced to 2.6 ifsPSA was detectable. The pooled Mantel–Haenszel OR of 4.2 suggestedthat a detectable uPSA quadrupled the risk of recurrence,independent of whether sPSA was elevated or not. The sensitivityof uPSA for detecting future sPSA recurrences was 81% andspecificity was 45%.Conclusion: Urinary PSA could contribute to an early detection oflocal recurrences of prostate cancer after a radical prostatectomy.Objectif : Nous avons évalué le rôle de l’antigène prostatiquespécifique (APS) urinaire dans le suivi du cancer de la prostateaprès prostatectomie radicale rétropubienne (PRR) pour le dépistageprécoce de récidives locales.Méthodes : Cinquante patients atteints de cancer de la prostatetraités par PRR et n’ayant présenté aucune récidive avec anomaliede l’APS dans l’année suivant l’intervention chirurgicale ontété inscrits à une étude transversale par épreuves de laboratoireavec suivi longitudinal prospectif sur 6 ans. L’échec sur le planbiochimique était défini comme un taux d’APS sérique de 0,3 μg/Lou plus. Les patients devaient fournir des échantillons de sanget un échantillon d’urine du matin de 50 mL. Les analyses statistiquesreposaient sur le test de Wilcoxon et la méthode exactede Fisher.Résultats : La valeur médiane de l’APS sérique était de 0,13 μg/L.La valeur médiane de l’APS urinaire était de 0,8 μg/L; la différenceétait non significative quand on tenait compte des scores deGleason ou des stades pathologiques. Sur les 50 patients,27 présentaient des taux d’APS sérique non décelables au début,mais des taux d’APS urinaire décelables; 11 patients ont présentéun échec quant aux taux d’APS sérique après 6 ans. Six patientsavaient des taux d’APS sérique et urinaire décelables au départ.Quinze patients n’avaient aucun taux décelable d’APS sérique ouurinaire, et aucun APS sérique n’était toujours décelable chez13 patients après 6 ans. Le rapport de risque d’un échec quantaux taux d’APS sérique après détection d’APS urinaire est de 4,5en l’absence d’un taux d’APS sérique décelable, mais diminueà 2,6 en présence d’un taux d’APS sérique décelable. Le rapportde risque cumulé de 4,21 calculé par la méthode deMantel–Haenszel porte à croire que des taux d’APS urinaire décelablesquadruplent le risque de présenter une récidive, queles taux sériques soient élevés ou non. La sensibilité du test dedépistage de l’APS urinaire pour la détection des récidives avecanomalie des taux sériques était de 81 %, et la spécificité, de 45 %.Conclusion : Le taux d’APS urinaire peut contribuer à un dépistageprécoce des récidives locales après une prostatectomie radicale.

Role of ultrasensitive prostate-specific antigen in the follow-up of prostate cancer after radical prostatectomy

2015 ◽  
Vol 33 (1) ◽  
pp. 16.e1-16.e7 ◽  
Author(s):  
Heikki Seikkula ◽  
Kari T. Syvänen ◽  
Samu Kurki ◽  
Tuomas Mirtti ◽  
Pekka Taimen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Specific Antigen

scholarly journals Prostate-Specific Antigen Dynamics After Carbon Ion Radiotherapy for Prostate Cancer

2020 ◽  
Author(s):  
Yosuke Takakusagi ◽  
Takahiro Oike ◽  
Kio Kano ◽  
Wataru Anno ◽  
Keisuke Tsuchida ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Carbon Ion Radiotherapy ◽  
Clinical Recurrence ◽  
Carbon Ion ◽  
Psa Bounce ◽  
Psa Failure ◽  
Risk Prostate Cancer

Abstract Background This study aimed to explain the dynamics of prostate-specific antigen (PSA) levels in patients with prostate cancer who were treated with carbon ion radiotherapy (CIRT) and neoadjuvant androgen-deprivation therapy (ADT). Methods Eighty-five patients with intermediate-risk prostate cancer who received CIRT and neoadjuvant ADT from December 2015 to December 2017 were analyzed in the present study. The total dose of CIRT was set at 51.6 Gy (relative biological effectiveness) delivered in 12 fractions over 3 weeks. The PSA bounce was defined as a ≥0.4 ng/ml increase of PSA levels from the nadir, followed by any decrease. PSA failure was defined using the Phoenix criteria.Results The median patient age was 68 (range, 48–81) years. The median follow-up duration was 33 (range, 20–48) months. The clinical T stage was T1c, T2a, and T2b in 26, 44, and 14 patients, respectively. The Gleason score was 6 in 3 patients and 7 in 82 patients. The median pretreatment PSA level was 7.37 (range, 3.33–19.0) ng/ml. All patients received neoadjuvant ADT for a median of 6 (range, 2–116) months. PSA bounces were observed in 39 patients (45.9%), occurring a median of 12 (range, 6–30) months after CIRT. PSA failure was observed in eight patients (9.4%), occurring a median of 21 (range, 15–33) months after CIRT. The 3-year PSA failure-free survival rate was 88.5%. No clinical recurrence was observed during the follow-up period. Younger age was a significant predictor of PSA bounces and PSA failure. Conclusions The dynamics of PSA levels after CIRT was investigated in the present study. Further follow-up is needed to reveal the clinical significance of PSA dynamics.

scholarly journals Prostate-specific antigen dynamics after neoadjuvant androgen-deprivation therapy and carbon ion radiotherapy for prostate cancer

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241636
Author(s):  
Yosuke Takakusagi ◽  
Takahiro Oike ◽  
Kio Kano ◽  
Wataru Anno ◽  
Keisuke Tsuchida ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Antigen ◽  
Androgen Deprivation Therapy ◽  
Specific Antigen ◽  
Carbon Ion Radiotherapy ◽  
Carbon Ion ◽  
Younger Age ◽  
Psa Bounce ◽  
Psa Failure

Background This study aimed to explain the dynamics of prostate-specific antigen (PSA) levels in patients with prostate cancer who were treated with carbon ion radiotherapy (CIRT) and neoadjuvant androgen-deprivation therapy (ADT). Methods Eighty-five patients with intermediate-risk prostate cancer who received CIRT and neoadjuvant ADT from December 2015 to December 2017 were analyzed in the present study. The total dose of CIRT was set at 51.6 Gy (relative biological effectiveness) delivered in 12 fractions over 3 weeks. The PSA bounce was defined as a ≥0.4 ng/ml increase of PSA levels from the nadir, followed by any decrease. PSA failure was defined using the Phoenix criteria. Results The median patient age was 68 (range, 48–81) years. The median follow-up duration was 33 (range, 20–48) months. The clinical T stage was T1c, T2a, and T2b in 27, 44, and 14 patients, respectively. The Gleason score was 6 in 3 patients and 7 in 82 patients. The median pretreatment PSA level was 7.37 (range, 3.33–19.0) ng/ml. All patients received neoadjuvant ADT for a median of 6 (range, 2–117) months. PSA bounces were observed in 39 patients (45.9%), occurring a median of 12 (range, 6–30) months after CIRT. PSA failure was observed in eight patients (9.4%), occurring a median of 21 (range, 15–33) months after CIRT. The 3-year PSA failure-free survival rate was 88.5%. No clinical recurrence was observed during the follow-up period. Younger age and lower T stage were significant predictors of PSA bounce. Younger age was a significant predictor of PSA failure. Conclusions In this study, we identified the significant predictors of the occurrence of PSA bounce and failure. Further follow-up is needed to reveal the clinical significance of PSA dynamics.

Radical Prostatectomy Versus Observation in Early Prostate Cancer

2021 ◽  
pp. 31-36
Author(s):  
Philipp Dahm
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Cancer Mortality ◽  
Watchful Waiting ◽  
Specific Antigen ◽  
Prostate Cancer Mortality ◽  
Cancer Group

This chapter provides a summary of the landmark Scandinavian Prostate Cancer Group Study Number 4 trial of men with clinically localized prostate cancer from the pre–prostate-specific antigen (PSA) era who were randomized to radical prostatectomy versus watchful waiting and were followed long term. With follow-up of more than 20 years, the results favored surgery with regard to prostate cancer mortality.

scholarly journals Prostate-specific antigen bounce after 125I-brachytherapy for prostate cancer is a favorable prognosticator in patients who are biochemical recurrence-free at 4 years and correlates with testosterone

2019 ◽  
Vol 50 (1) ◽  
pp. 58-65 ◽  
Author(s):  
Yasushi Nakai ◽  
Nobumichi Tanaka ◽  
Isao Asakawa ◽  
Satoshi Anai ◽  
Makito Miyake ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Antigen ◽  
Biochemical Recurrence ◽  
Specific Antigen ◽  
Testosterone Levels ◽  
Psa Bounce ◽  
125I Brachytherapy ◽  
Psa Nadir ◽  
Free Rate

Abstract Background Because patients with prostate-specific antigen (PSA) bounce do not experience biochemical recurrence (BCR) until PSA bounce occurs, the period until PSA bounce ends can be considered the so-called lead-time bias. Therefore, we evaluated differences in BCR-free rate in prostate cancer patients who were BCR-free 4 years after 125I-brachytherapy alone. Furthermore, we evaluated predictors for PSA bounce and the correlation between testosterone and PSA bounce. Methods From 2004 to 2012, 256 patients with prostate adenocarcinoma underwent 125I-brachytherapy alone. PSA and testosterone levels were monitored prior to 125I-brachytherapy, at 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54 and 60 months after 125I-brachytherapy and yearly after 5-year follow-up. PSA bounce was defined as ≥0.2 ng/ml increase above the interval PSA nadir, followed by a decrease to nadir or below. Results BCR-free rate in patients with PSA bounce (100% 7-year BCR-free rate) was significantly better (P < 0.044) than that in patients without PSA bounce (95.7% 7-year BCR-free rate) in patients who were BCR-free 4 years after 125I-brachytherapy alone (n = 223). Age was the only predictor (odds ratio: 0.93, 95% confidence interval: 0.88–0.98, P = 0.004) for PSA bounce (n = 177). The testosterone level at PSA bounce was significantly higher (P = 0.036) than that at nadir before PSA bounce (87 cases). Conclusions Patients with PSA bounce had good BCR-free rate even in patients who were BCR-free 4 years after 125I-brachytherapy alone. Testosterone levels were higher at PSA bounce; increased testosterone levels may be a cause of PSA bounce.

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